Scrubs by Anel Viz

Scrubs

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My name is Dr. Robert S. Watson, ME. I work for the Sheriff’s Department of Los Angeles County. For most of my life I’ve gone by the nickname Bobby, but during my internship everyone at the hospital called me Sherlock, because I intended to specialize in forensic medicine and my middle name is Sherman. It began as a tease, and after a couple of weeks the joke wore thin and people stopped using it, until one of life’s extraordinary coincidences set it in stone.

I trained at one of the country’s major teaching hospitals, also in Los Angeles. To give us interns experience in all aspects of medicine, our assignments sent us to every department of the hospital on a rotating schedule, including – and most particularly – the emergency room. As a rule, we made our rounds in groups under the supervision of one of the staff physicians, but new interns worked the emergency room in smaller groups between early and mid morning, the slowest time of day, since at other times it tended to be crowded and the pace hectic.

That day there were four of us under Dr. Stanley Sanders, a kind and patient man with gray hair and a wry, understated sense of humor – Marcia Livingston, Doug Veres, Rajiv Patel and myself. The emergency room was empty when we arrived at seven o’clock, so we sat around in the lounge drinking coffee, waiting for something to do.

About twenty minutes later a man arrived, complaining of an erection that would not subside. He could barely walk, doubled over and clutching his groin in agony. He said that his condition had lasted about six hours. His name was John Holmes.

While a nurse led him to an examining room for prepping, Dr. Sanders quizzed us on his condition.

“What is it called when a penis will not lose an erection?”

Without hesitation, Doug answered, “Priapism.”

“And is it serious?”

“It can be very serious, and requires immediate attention.”

“What are the dangers involved?”

We took turns listing the possible complications – ischemia, blot clots in the erectile tissue, damage to the blood vessels, etc. Blood vessel damage can cause impotence, and ischemia can lead to gangrene, in which case the penis would need to be amputated.

“How long do we advise a patient to wait before seeking medical treatment?”

“Four hours,” Marcy said, “and this man’s erection has gone on for six, so...”

The nurse returned and interrupted us.

“Is Mr. Holmes ready?” Dr. Watson asked.

“No, Doctor. He can’t manage to undress himself, and I can’t manage it either. Will we have to cut his pants off him?”

“I don’t think that will be necessary. We doctors should be able to get them off.”

Holmes had taken off his shirt, shoes and socks, but could go no further unaided. It was a bit of a tug to get his pants down, but his penis was so engorged that we could move it neither up nor down, and it protruded to the extent that the elastic waistband of his boxers would not stretch far enough to clear it, and they had to be cut off.

Marcy fainted, and Rajiv’s eyes bulged. Doug’s eyes bulged too, and I thought he might start drooling. I have no idea what I expression I wore on my face.

“Whom should we see to first?” asked Dr. Sanders, not the least perturbed. “Dr. Livingston, I presume.”

“Any one of the nurses can see to her,” I replied. “The patient’s condition is more pressing.”

“Excellent, Watson. Please call for an orderly to remove her from underfoot and give us room to work. Now, who can tell me what treatment is recommended?”

We fell silent. None of us had encountered a case of priapism before, and we didn’t want to make fools of ourselves.

“Will no one hazard a guess? Veres, you plan to go into urology. Do be so good as to tell us what causes an erection.”

“Flow of blood into the penis, where it is retained by the spongy tissue on either side of the urethra.”

“And the medical term for this spongy tissue is?”

“The corpora cavernosa.”

“Very good. Knowing that, what procedure do you propose we should follow?”

“Drain the blood that’s collected in the penis?”

“I would have thought that would be obvious to all. And how do you propose we do that?”

“By aspiration.”

“As a budding urologist, that will be your job. Send for a nurse and have her bring the necessary instruments.”

Dr. Sanders continued to quiz us while the nurse was getting the tray ready. “Before we begin, do any of you have any questions?”

“I was wondering,” Rajiv began, “if all Caucasians...”

“Don’t I wish,” Doug muttered under his breath.

“Surely you know the answer to that,” Dr. Sanders replied archly. “If you don’t, ask around.”

“The guy could make a fortune in the porn industry,” Doug informed Rajiv.

“I have already,” Holmes groaned, his face contorted in pain. It was the first time he’d spoken, though I thought I’d detected a gleam of triumph in his eyes when Marcy fainted.

“Christ Almighty! How big is that thing?” (Doug again.)

“Fourteen inches. Measure it yourself if you don’t believe me.”

It would not have surprised me if he went for a tape measure, but Dr. Sanders stopped him. Up to that point he had showed no impatience with their unprofessional exchange. Perhaps he meant to have a little talk about bedside manner with Doug later.

“I have a few questions I’d like to ask,” he said. “For example, what is the most common cause of priapism?”

“I’m guessing it could result from either some vascular or neurological disorder.”

“You’ve done your homework, Watson. Any number of such disorders might be involved, as well as Anderson-Fabry disease, which is...?”

As none of us knew, he went on, “...angiokeratoma corporis diffusum, an inherited lysosomal storage disease. But the exact cause, if there is only one, remains a mystery. That would put it right up your alley, wouldn’t it Sherlock?” From the twinkle in his eye I inferred that his witticism had given him another idea and I hadn’t heard the last of it.

“Veres, what is one of the first questions we should ask the patient?”

“If he’s had the condition before.”

“Then ask him.”

Doug asked. He hadn’t.

“Could it also be a side effect of medications?” Rajiv asked. “Something like Viagra?”

“Don’t need the stuff,” Holmes protested in a feeble voice. But he sounded miffed.

“There is no evidence that implicates sidenafil or the other erection enhancing drugs. Antidepressants and antipsychotics are more likely to produce this side effect.”

He turned to the patient. “Has your doctor ever prescribed clozapine or trazodone?”

Holmes shook his head.

“Do you take anything for hypertension?”

Another negative response.

“What about recreational drugs? Alcohol, cocaine...”

“Both.”

“Have you used them recently?”

“Last night.”

“A lot?”

“More than usual.”

“And you had sex also?”

“A lot of that too.”

“That is good news. Prolonged erection can be a symptom of some very serious illnesses.”

The nurse arrived with the instrument tray. Marcy returned with her.

“Feeling better, Dr. Livingston? You anticipate no more mishaps?”

“I’m fine, thank you, Doctor.”

“The guy has fourteen inches!” Doug whispered.

“If you think you’re going to make me pass out again, you can forget it,” she replied coldly.

Doug had already put on the latex gloves.

“I’ve changed my mind, Veres,” Dr. Sanders said. “Wouldn’t it be more fitting for Dr. Watson to treat Mr. Holmes? It doesn’t matter that the first names are reversed.”

I thought Doug looked very disappointed. I put on the gloves and waited for Dr. Sanders’s instructions.

“Go ahead, Watson. Administer a local anesthetic.”

I filled the syringe and gently held Holmes’s penis between the thumb and forefinger of my left hand. “This will just be a little prick,” I told him.

He attempted a brave smile. “Even when it’s soft it’s not a little prick. Ow!”

Dr. Sanders filled us in on what we could expect to happen next while we waited for the anesthetic to take effect.

“If aspirating the patient doesn’t work, the medical books prescribe phenylephrine by intra-cavernosal injection. Only a urologist should do that, as he’ll need hemodynamic monitoring. Patel, what conditions may result from injecting phenylephrine?”

Rajiv rattled them off. Holmes didn’t seem particularly alarmed. The big words probably didn’t mean anything to him.

“If so,” Dr. Sanders went on, “he’ll have to be moved to urology. I believe Dr. Ernst is on call today. Am I right, Ms. Grabois?” he asked the nurse.

She nodded.

“Will you please call urology and see if they have a bed available? If it becomes necessary to send him to urology, Veres, I’ll make an exception and allow you assist Dr. Ernst, seeing that you’re interested in urology. We aren’t likely to run into another case of priapism for a long time to come.”

Marcy saw an opening to get back at Doug and jumped at the chance. “I think Dr. Veres would sooner go down on it than see it go down.”

Doug blushed dark crimson. Rajiv started to giggle.

“Let’s not have any more jokes,” Dr. Sanders admonished her. “Watson here needs a steady hand.”

My hand was perfectly steady. Holmes, on the other hand, couldn’t stop laughing.

“Will someone please tell me what’s so funny? Are you doctors or dirty-minded adolescents? Get a hold of yourselves before Nurse Grabois gets back or I don’t know what she’ll think!”

“Sherlock Watson treating John Holmes,” Rajiv said, gasping for breath. He said it just when the nurse walked into the examining room, and she started laughing too. Soon the tears were rolling down her cheeks.

That did it; the name stuck. From then on no one on the staff called me anything but Sherlock.

Although he had first made the joke, Dr. Sanders was unmoved.

“This is no laughing matter. Phenylephrine entails a high degree of risk, and if that’s ineffective Dr. Ernst will need to do a surgical shunt. Do you know what that involves, Mr. Holmes? A dystal shunt means puncturing the head of your penis to drain the blood. For a proximal shunt you’ll have to go to the operating room, where he’ll dissect your perineum – you know what that is? – ”

Holmes nodded. The thought of being cut open at the base of his scrotum had sobered him immediately.

“He’ll also make an incision in the spongy tissue surrounding your urethra and then suture the two together,” Dr. Sanders concluded.

His words struck me as unnecessarily harsh. I tried to reassure my patient.

“ I’m certain it won’t come to that. This almost always does the trick, doesn’t it, Doctor?”

“Yes, almost always.”

“Then just do it,” Holmes said, “so I can go back home and forget about it.”

“You’ll have to stay here an hour or so to make sure it doesn’t recur,” Dr. Sanders explained. “Dr. Veres will come by and check you every fifteen minutes. Won’t you, Veres?”

Doug eagerly nodded agreement.

“Just take a look at it, Veres. Any other attentions and we could be right back where we started.”

I hadn’t performed any procedure like it before, so I did the job carefully and very slowly. It took me a good two minutes to fill the syringe with blood. His erection went down a little, but not nearly enough.

“It’s not working, is it?” Holmes said, a look of panic on his face.

“If you really have fourteen inches there we’ll have to use a much larger syringe,” Dr. Sanders said. “That it went down at all is a good sign.”

In all I drained some twelve cubic centimeters of blood from him. He was quite soft now, but the thing still hung halfway down his thigh.

Doug had him stay longer than the two hours Dr. Sanders suggested, and disappeared every ten minutes for another look at him. Holmes finally checked out shortly after noon.

Doug, Rajiv and I had our lunch together in the cafeteria. We invited Marcy to join us, but she refused.

“I know what case you’ll be debriefing,” she said, “and frankly, I’m not interested.”

Doug was positively beaming when he sat down at the table.

“What are you so happy about?” I asked. “As if I don’t know.”

I didn’t.

“He says he owes me,” Doug answered. “He gave me his address.”

Posted: 08/15/08